EP2361035B1 - Système pour déterminer l'état d'insuffisance cardiaque - Google Patents

Système pour déterminer l'état d'insuffisance cardiaque Download PDF

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Publication number
EP2361035B1
EP2361035B1 EP09792660.4A EP09792660A EP2361035B1 EP 2361035 B1 EP2361035 B1 EP 2361035B1 EP 09792660 A EP09792660 A EP 09792660A EP 2361035 B1 EP2361035 B1 EP 2361035B1
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Prior art keywords
heart failure
status
information
physiologic
patient
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German (de)
English (en)
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EP2361035A1 (fr
Inventor
Yi Zhang
Jeffrey E. Stahmann
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Cardiac Pacemakers Inc
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Cardiac Pacemakers Inc
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Definitions

  • a body can be thought of as a group of systems working together to maintain a person's health.
  • the circulatory system can be responsible for providing oxygen and nutrients to various organs.
  • the heart can be thought of as the central organ of the circulatory system.
  • the left portions of the heart can draw oxygenated blood from the lungs and supply it to other parts of the body.
  • the body can use the oxygenated blood as part of a metabolic cycle.
  • the metabolic cycle can partially deoxygenate the blood while providing energy to organs or muscle tissue.
  • the right portions of the heart can then return such deoxygenated blood to the lungs where the blood can become oxygenated again.
  • a variety of physiologic conditions can affect the mechanical or electrical behavior of the heart.
  • a disease such as heart failure (“HF") can reduce the pumping capability or efficiency of the heart.
  • HF heart failure
  • the reduced pumping capability or efficiency of the heart can cause other undesirable symptoms, such as edema (retention of body fluid), weight gain, shortness of breath, poor exercise tolerance, sleeping related problems, or other undesirable symptoms, and can ultimately lead to death.
  • One or more systems or methods can be used to monitor various physiologic parameters to predict a worsening heart failure status of a patient.
  • a sudden worsening of HF-related signs or symptoms can be referred to as acute heart failure decompensation ("AHFD").
  • AHFD acute heart failure decompensation
  • a person having heart failure can sometimes be unaware of such changes in physiologic status.
  • Automatic warning or alert generation systems or methods can assist in early identification of a worsening condition or other significant disease events.
  • Treatment of HF can then be initiated or modified. Treatment can include initiating or modifying pharmacological therapy, using an implantable device (e.g., cardiac resynchronization therapy or one or more other therapies), physiologic monitoring (e.g., through one or more sensors), or the like.
  • Early detection of worsening heart failure can reduce the frequency and the length of hospitalization, improve quality of life, or reduce health care costs.
  • one or more symptoms or conditions unrelated to heart failure can distort a person's perception of the severity of heart failure-related symptoms. Such distortion can be referred to as heart failure symptom amplification.
  • heart failure symptom amplification The present inventors have recognized, among other things, that changing the detection criteria of a method or system to provide an alert for a worsening heart failure condition can be beneficial for persons experiencing symptom amplification.
  • a user interface can be used to obtain information about a person's symptoms or conditions.
  • heart failure status detection criteria can be changed automatically in response to one or more selected symptoms or conditions.
  • the user interface can be configured to show a clinical indication, such as a disease symptom or physiologic condition to be selected. By selecting a disease symptom or physiologic condition, the user can provide control over heart failure status detection criteria.
  • the user need not have familiarity with technical details about the configuration of one or more sensors or alert generation settings.
  • the one or more sensors or alert generation settings can be determined automatically in response to the user input.
  • the user interface can be simplified.
  • US 2005/0137481 A1 discloses a device for remote management of patients suffering from heart failure, which comprises the features of the preamble of claim 1.
  • one or more changes in physiologic patient status parameters can predict the onset or worsening of heart failure.
  • Clinical terms can be used to describe such changes, such as "increasing wetness” (e.g., worsening pulmonary edema, peripheral edema or one or more other forms of edema) or "decreasing exercise tolerance.”
  • Physiologic patient status can be derived from information provided by various sensors or by using information provided by a user.
  • implantable medical devices (IMD's) or external devices can provide one or more sensors.
  • the one or more sensors can include a weight scale, a blood pressure sensor (e.g., a blood pressure cuff or an implantable sensor), an electrocardiogram ("ECG") sensor, an accelerometer, an activity sensor (e.g ., an piezoelectric accelerometer, or other sensor), an intrathoracic impedance sensor, an acoustic sensor, a respiration sensor, a blood gas (e.g., oxygen or one or more other gases) sensor, or one or more other sensors.
  • a blood pressure sensor e.g., a blood pressure cuff or an implantable sensor
  • ECG electrocardiogram
  • an accelerometer e.g., an activity sensor (e.g ., an piezoelectric accelerometer, or other sensor)
  • an intrathoracic impedance sensor e.g., an acoustic sensor
  • respiration sensor e.g., a respiration sensor
  • a blood gas e.g., oxygen or one or more other gases
  • Examples of information obtained from the one or more sensors can include heart rate, respiration rate, respiration timing, blood pressure, lung tidal volume, physical activity level, exercise tolerance (e.g., a patient's physiologic response to physical activity), weight, intrathoracic impedance (e.g., to asses fluid build-up, to monitor respiration-related parameters, or to monitor cardiac-related parameters), heart sound timing, heart sound magnitude (e.g., an S3 heart sound magnitude), or other information.
  • physiologic response to physical activity can be determined by monitoring a patient's physical activity level using an accelerometer, and monitoring a corresponding respiration rate, or heart rate.
  • an onset of pulmonary edema e.g., abnormal retention of fluid in the lungs or bronchi
  • an intrathoracic impedance sensor e.g., an intrathoracic impedance sensor
  • information e.g., data
  • information can be compared with a specified range of values, and when the information meets or exceeds the range, an alert can be generated.
  • a maximum, minimum, moving average, weighted average, median, mean, or another central tendency of sensor data can be called a "baseline" and compared to a specified range and an alert can be generated when the compared value meets or exceeds the range.
  • a detected variation of sensor data from a baseline can be used to trigger an alert.
  • a rate of change or trend of sensor data can be compared to a threshold or range and an alert can be generated when the rate of change or trend meets or exceeds the threshold or range.
  • an alert range for information from a sensor can be specified or modified by a user (e.g ., a clinician, a patient, a caregiver, a physician, or one or more others), using a user interface.
  • the user interface can also be used to change, or confirm monitoring parameters (e.g., a sensor configuration) or worsening HF detection criteria.
  • an external device e.g., a portion of a patient monitoring system
  • an implantable medical device can be programmed with the modified sensor configuration or alert generation criteria (e.g ., worsening HF detection criteria).
  • FIG. 1 illustrates generally an example of at least a portion of system 100 for determining heart failure status.
  • the system 100 can include a user input 110, communicatively coupled to a first display 120A.
  • the first display 120A can include a plurality of user-selectable heart failure symptom indicators 130, and a user-selectable abnormal psychological condition indicator 140.
  • the first display 120A can be communicatively coupled to a heart failure ("HF") status processor 150.
  • the HF status processor 150 can be communicatively coupled to a second display 120B.
  • the second display 120B can include a heart failure (“HF") status indicator 160, and the indicator 160 can be configured to be controllably adjusted by the HF status processor 150, such as a by a heart failure status detection method as shown in FIG. 13 .
  • a person 170 e.g., a patient
  • the physiological patient status parameter detector 180 can be coupled to the HF status processor 150.
  • the first display 120A and second display 120B can include the same display (e.g., a single personal computer display).
  • the user input 110 can include a keyboard, mouse, touch-screen or the like.
  • the first display 120A or the user input 110 can be included as a portion of a physician programmer assembly for use in communication with an implantable medical device ("IMD”) (e.g., a cardiac rhythm management (“CRM”) device), or as a portion of an external patient monitoring assembly (e.g., a bedside monitor located in a person's home).
  • IMD implantable medical device
  • CRM cardiac rhythm management
  • FIG. 2 illustrates generally an example of at least a portion of a system 200 for determining a worsening heart failure condition including an HF status processor 150 and an HF status indicator 160.
  • the HF status processor 150 can include an HF status detector 210
  • the HF status indicator 160 can include a worsening HF condition indicator 220.
  • the HF status detector 210 can be communicatively coupled to the worsening HF condition indicator 220.
  • the HF status processor 150 or HF status detector 210 can be included as a portion, part, or component of an IMD, such as a CRM device.
  • the HF status processor 150 or HF status detector 210 can be included as a portion, part, or component of an external assembly, such as a computer server, a personal computer, an external patient monitoring assembly, etc.
  • FIG. 3 illustrates generally an example of at least a portion of system 300 including an HF status processor 150 and an HF status indicator 160.
  • the HF status processor 150 can include an HF status detector 210 configured to determine a heart failure status
  • the HF status indicator 160 can include a worsening HF condition indicator 220 configured to indicate a worsening HF condition.
  • the HF status processor 150 and HF status detector 210 can be communicatively coupled to the HF status indicator 160 and the worsening HF condition indicator 220.
  • the HF status processor 150 can be configured to control at least one of a sensitivity 310, a specificity 320, a positive predictive value 330, or a negative predictive value 340 of a heart failure status determination, such as a worsening heart failure condition determination performed by the HF status detector 210.
  • a sensitivity 310 can be thought of as the likelihood that an actual positive condition can be accurately detected (e.g., a ratio of true positive detection events to the total number of actual positive events).
  • a positive detection event can be thought of as detecting a worsening HF condition (whether or not one actually exists).
  • Increasing a sensitivity 310 can make a detection event more likely.
  • an increased sensitivity 310 can result in a greater likelihood of declaring a worsening HF condition, even though the underlying likelihood of an actual worsening HF condition has not changed.
  • a higher sensitivity 310 can result in fewer false negatives at the expense of more false positives.
  • an alert e.g ., a worsening heart failure condition, an alarm on an individual sensor, an alarm on a patient status parameter, etc.
  • reducing a threshold value can make a threshold crossing more likely.
  • the threshold crossing due to such other factors can also be more likely (e.g ., due to noise, comorbidities, malfunction, inherent limits to sensing resolution, or the like). If the threshold crossing occurs due to other factors, it can be referred to as a false positive.
  • a specificity 320 can be thought of as the likelihood that an actual negative event results in a negative detection event (e.g., the HF status detector 210 does not detect a condition, and the condition is not occurring or has not occurred).
  • a negative detection event can be thought of as not detecting an actual worsening HF condition.
  • a higher specificity 320 can be thought of as more likely to register a true negative detection event, at the expense of more false negative events. Generally, the higher specificity 320 can result in fewer false positives.
  • the specificity 320 and the sensitivity 310 can be related to, but not dependent on, each other, and a more robust detection scheme can result in both a higher specificity and a higher sensitivity.
  • a Positive Predictive Value (“PPV”) 330 can be thought of as a ratio of true positive detection events to a total number of positive detection events. In the example of a worsening heart failure condition determination, a higher PPV 330 can be associated with a lower false positive rate.
  • a Negative Predictive Value (“NPV”) 340 can be thought of as a ratio of true negative detection events to a total number of negative detection events, and a higher NPV 340 can reduce a false negative rate.
  • FIG. 4 illustrates generally an example of at least a portion of a user interface 400.
  • the user interface 400 can be included as a portion of a system or method for determining heart failure status.
  • the user interface 400 can include a user-selectable display of one or more heart failure symptoms 130, of one or more comorbidities 420, and one or more psychological conditions 140.
  • the user-selectable heart failure symptoms 130 can include dyspnea, edema, weight change, or one or more other heart failure symptoms, and one or more radio buttons (e.g ., radio button 430) can indicate a user selection.
  • a check-box, list box, or other user-selectable input can be used, ( e.g ., the selections need not be mutually exclusive).
  • the radio button 430 can be selected by a user via an input device to a computer (e.g ., a keyboard, a mouse, or the like).
  • the user interface 400 can be provided to a user via telephonic communication (e.g., either by another person, or an automated voice response system), and the user can provide inputs using speech, a touch-tone keypress, or one or more other method.
  • telephonic communication e.g., either by another person, or an automated voice response system
  • the user can provide inputs using speech, a touch-tone keypress, or one or more other method.
  • dyspnea can include one or more of dyspnea-on-exertion (e.g., a shortness of breath during physical activity), dyspnea-at-rest, nocturnal paroxysmal dyspnea (e.g., a transient shortness of breath or labored breathing during nighttime, or during sleep), orthopnea (e.g., a shortness of breath or labored breathing depending on whether a person is standing upright or lying down), dyspnea-on-anxiety, or one or more other subdivisions or subcategories of dyspnea.
  • dyspnea-on-exertion e.g., a shortness of breath during physical activity
  • dyspnea-at-rest e.g., a transient shortness of breath or labored breathing during nighttime, or during sleep
  • orthopnea e.g., a shortness of breath or labored breathing depending on whether a person is standing upright or lying
  • other heart failure symptoms can include one or more of pulmonary edema, generalized edema, peripheral edema, ascites, a positive weight change, a negative weight change, etc.
  • the user-selectable comorbidities 420 can include asthma, chronic obstructive pulmonary disease ("COPD"), pulmonary hypertension, anemia, apnea, or one or more other comorbidities.
  • Information about the user selection of the user-selectable comorbidities 420 can be used in the HF status determination.
  • a worsening heart failure status determination can disregard or deemphasize data from one more sensors associated with the comorbidity to avoid a false detection of a worsening heart failure condition.
  • a person can have both asthma and pulmonary edema.
  • a worsening heart failure status determination can weigh information from an intrathoracic impedance measurement (e.g ., to asses fluid build up) more heavily using a first weight than information related to respiration rate or respiration timing using a second weight (e.g ., since respiration-related information can be confounded by the asthma).
  • the specificity 320 of the worsening heart failure condition determination can be increased.
  • the user-selectable psychological conditions 140 can provide a plurality of abnormal psychological conditions including depression, anxiety, or other stresses or psychological conditions.
  • the first or second weights can be coefficients used in a numerical calculation, a threshold value, a sensor selection, a gain value (e.g., for a sensor from which physiologic status information can be obtained), a shape of a membership function or coefficient used in a fuzzy logic decision scheme, a coefficient or path through a neural network decision scheme, or the like.
  • a window can then be displayed on a display showing one or more proposed alert threshold changes (e.g., for an individual sensor or a physiologic patient status alert, for a worsening HF condition alert, or both).
  • the window can show one or more device programming changes, sensor configuration changes, etc., and confirmation or override of the one or more changes can be received via a user input.
  • a heart failure therapy can be delivered or modified in response to the user selection.
  • FIG. 5 illustrates generally an example of at least a portion of a system 500 for determining heart failure status including a first external device 510, a second external device 520, a network 530, an implantable sensor assembly 550, and an external sensor assembly 540.
  • the first external device 510 can be coupled to the second external device 520 through the network 530 using a first communicative coupling 580A, or a second communicative coupling 580B.
  • the first external device 510 can include a first display 120A and a first user input 110A.
  • the second external device 520 can include a second display 120B and a second input 110B.
  • the second external device 520 can include a telemetry circuit 560 configured to communicatively couple the second external device 520 to the implantable sensor assembly 550 using a first wireless communicative coupling 570A, or to communicatively couple the second external device 520 to the external sensor assembly 540 using a second wireless communicative coupling 570B.
  • the external sensor assembly 540 can include at least one of a blood pressure sensor, a respiration sensor, a weight scale, or one or more other external sensors.
  • the implantable sensor assembly 550 can include a CRM device implanted within a person 170.
  • the implantable sensor assembly 550 can be coupled to a heart 590 via a lead, and can include cardiac resynchronization therapy delivery circuitry, pacing circuitry, or tachyarrhythmia therapy circuitry (e.g ., antitachyarrhythmic pacing or defibrillation shock).
  • the implantable sensor assembly 550 can include one or more of a blood pressure sensor, an intrathoracic impedance sensor, a respiration sensor (e.g ., capable of sensing respiration rate, respiration timing, lung tidal volume, minute ventilation, or one or more other respiratory parameters), an acoustic sensor (e.g ., to detect heart sounds), an activity level sensor (e.g ., an accelerometer or a piezo-electric sensor to detect a person's physical activity, or one or more other activity level sensors), an electrocardiogram sensor, or one or more other implantable sensors.
  • a blood pressure sensor e.g ., an intrathoracic impedance sensor
  • a respiration sensor e.g ., capable of sensing respiration rate, respiration timing, lung tidal volume, minute ventilation, or one or more other respiratory parameters
  • an acoustic sensor e.g ., to detect heart sounds
  • an activity level sensor e.g ., an accelerometer or a piez
  • one or more additional sensor assemblies can be implanted (e.g ., an intravascular pressure sensor), and can communicate with either the implantable sensor assembly 550 or with one or more other implantable or external devices.
  • the second external device 520 can include the external sensor assembly 540, and the wireless coupling 570B can be omitted or replaced by a another wired or wireless coupling.
  • the first external device 510 can include a personal computer connected to the network 530 (e.g., for use by a caregiver, a clinician, a patient, a physician, etc., at a convenient location).
  • the second external device 520 can include a physician programmer or a patient monitoring assembly (e.g., a home bed-side monitor, or the like).
  • FIG. 6 illustrates generally an example of at least a portion of a method 600 to determine heart failure status using a user input and information obtained from a first physiologic patient status parameter.
  • one or more heart failure symptoms 130 can be displayed, such as shown in FIG. 4 , such as on a first display 120A or a second display 120B.
  • one or more psychological conditions 140 can be displayed, such as shown in FIG. 4 , such as on a first display 120A or a second display 120B.
  • a user selection can be received indicating that one or more abnormal psychological conditions is or has been present, such as by one or more radio buttons (e.g ., radio button 430) or by another user-selectable input (e.g., a check box, list box, or one or more other inputs).
  • a user selection can be received indicating that at least one heart failure symptom is or has been present, such as by using a radio button 430.
  • a user selection can be received indicating that none of the one or more heart failure symptoms displayed at 610 is or have been present.
  • one or more heart failure comorbidities can be displayed, such as shown in FIG. 4 .
  • a user selection can be received indicating that one or more heart failure comorbidities is or has been present, such as by one or more radio buttons (e.g . , radio button 430) or by another user-selectable input (e.g., a check box, list box, or one or more other inputs).
  • radio buttons e.g . , radio button 430
  • another user-selectable input e.g., a check box, list box, or one or more other inputs.
  • an HF status in response to the user selection at 630 and the user selection at 640, an HF status can be determined ( e.g ., controllably adjusted) using information about the user selection at 630, the user selection at 640, and a first physiological patient status parameter.
  • an HF status in response to the user selection at 630, the user selection at 640, and the user selection of the one or more heart failure comorbidities, an HF status can be determined ( e.g ., controllably adjusted) using information about the user selection at 630, the user selection at 640, the user selection of the one or more heart failure comorbidities, and a first physiological patient status parameter.
  • FIG. 7 illustrates generally an example at least a portion of a method 700 to determine heart failure status including, at 710, receiving information about a first physiologic patient status parameter including receiving at least one of heart rate ("HR”), respiration rate (“RR”), respiration timing (“RT”), blood pressure (“BP”), lung tidal volume (“TV”), physical activity level, weight, intrathoracic impedance, heart sound (“HS”) timing, or HS magnitude.
  • HR heart rate
  • RR respiration rate
  • RT respiration timing
  • BP blood pressure
  • TV lung tidal volume
  • physical activity level weight
  • intrathoracic impedance HS
  • HS heart sound
  • a first physiologic patient status parameter of wetness or fluid status in relation to an edema symptom can be derived using information from an intrathoracic impedance (e.g ., decreasing impedance can indicate fluid retention), a person's weight (e.g., increasing weight can indicate fluid retention), or one or more other sensors.
  • an intrathoracic impedance e.g ., decreasing impedance can indicate fluid retention
  • a person's weight e.g., increasing weight can indicate fluid retention
  • one or more other sensors e.g., one or more other sensors.
  • FIG. 8A illustrates generally an example of at least a portion of a method 800 to determine heart failure status.
  • a user selects an indicator 140 that an abnormal psychological condition is or has been present then at 820 at least one of a sensitivity 310, specificity 320, positive predictive value 330, or negative predictive value 340 of a worsening heart failure condition determination can be adjusted.
  • a user selects no abnormal psychological condition, then another user input can be processed at 840A.
  • FIG. 8B illustrates generally an example of at least a portion of a method 800 to determine heart failure status.
  • a sensitivity 310 of a worsening heart failure condition determination can be increased.
  • the present inventors have recognized that for patients suffering from anxiety, stress, depression, or one or more other abnormal psychological conditions, symptom amplification can occur. Such patients can be more likely to want treatment even though an objective severity of their symptoms might be no worse than a patient with no abnormal psychological condition. Hospitalization and follow-up care can be driven by a patient's perception of symptoms.
  • symptoms can drive therapy decisions for patients, and such symptom amplification can be important from a detection standpoint (e.g ., for prediction of impending need for hospitalization).
  • a patient experiencing symptom amplification can be more likely to seek treatment earlier in the heart failure disease progression than a patient without symptom amplification.
  • an alert threshold associated with a respiration-related physiological patient status parameter can be reduced, and can make an alert more likely thus increasing an alert sensitivity.
  • a respiration-related parameter can include shortness of breath, poor exercise tolerance, or one or more other physiologic status parameters.
  • another user input can be processed at 840B.
  • a user selection of one or more heart failure comorbidities can be received.
  • a determination of a status of the one or more heart failure comorbidities can be made.
  • at least one of a sensitivity 310, specificity 320, positive predictive value 330, or negative predictive value 340 of the determination of the status of the one or more heart failure comorbidities can be adjusted.
  • FIG. 9 illustrates generally an example of at least a portion of a method to determine heart failure status 900.
  • a user selects an indicator that edema (e.g., pulmonary edema) is or has been present, such as on a first display 120A using a first input 110A, or a second display 120B using a second input 110B, then at 920 information about a first physiologic patient status parameter such as wetness can be derived using intrathoracic impedance, or one or more other sensors.
  • a weight of information derived using intrathoracic impedance, or information derived or received from one or more other sensors can be increased if edema is selected at 910.
  • an alert threshold can be established associated with an intrathoracic impedance, and the intrathoracic impedance can be compared with the alert threshold. If the impedance is at or below the threshold, a worsening heart failure condition determination can indicate worsening HF status, or an edema-specific alert can be generated, or both.
  • one or more existing thresholds associated with the intrathoracic impedance can be increased if edema is selected at 910, making one or more alerts more likely. In FIG. 9, at 910, if edema is not selected, then another user input can be processed at 930.
  • an alert can be displayed by the first external device 510, or the second external device 520, or via an electronic communication (e.g., an electronic mail message, a telephone message, a facsimile ("fax") communication, a user-accessible world wide web application, etc.).
  • an electronic communication e.g., an electronic mail message, a telephone message, a facsimile ("fax") communication, a user-accessible world wide web application, etc.
  • FIG. 10 illustrates generally an example of at least a portion of a method to determine heart failure status 1000.
  • a user selects that dyspnea is or has been present, such as on a first display 120A using a first input 110A, or a second display 120B using a second input 110B
  • information about a first physiologic patient status parameter such as shortness of breath or exercise tolerance can be derived using information obtained using at least one of respiration rate, respiration timing, heart rate, lung tidal volume, physical activity level, or one or more other sensors.
  • a weight of information derived using at least one of respiration rate, respiration timing, heart rate, lung tidal volume, physical activity level, or information derived or received from one or more other sensors can be increased if dyspnea is selected at 1010.
  • an exercise tolerance can be evaluated by using information about heart rate and physical activity level, or respiration rate and physical activity level, or one or more other sensors.
  • an excessive heart rate combined with a relatively moderate physical activity level can indicate poor exercise tolerance.
  • FIG. 1010 at 1010, if dyspnea is not selected, then another user input can be processed at 1030.
  • FIG. 11 illustrates generally an example of at least a portion of a method to determine heart failure status 1100.
  • one or more physiological patient status parameters can be used to detect one or more abnormal psychological conditions in addition to or instead of using a user selection.
  • information obtained from a first physiological patient status parameter can be compared with a first alert threshold or range.
  • an abnormal psychological condition can be declared as detected (e.g., without requiring a user selection of the abnormal psychological condition).
  • an alert or warning can be generated.
  • the comparison of the information with the first alert threshold fails to meet or exceed the threshold, then at 1140 the one or more abnormal psychological conditions need not be declared as detected.
  • FIG. 12 illustrates generally an example of at least a portion of a method to determine heart failure status 1200.
  • one or more physiologic patient status parameters can be used to detect one or more HF symptoms in addition to or instead of using a user selection.
  • information obtained from a first physiological patient status parameter can be compared with a second alert threshold or range.
  • the one or more HF symptoms can be declared as detected (e.g., without requiring a user selection of the one or more symptoms).
  • a lower threshold for intrathoracic impedance, or one or more other sensors can be established.
  • an intrathoracic impedance is decreasing, such information can be used to determine that a physiologic patient status of wetness can be increasing. If wetness increases such that it meets or exceeds a threshold, then the heart failure symptom of edema can be declared as detected. In FIG. 12, at 1220, if the comparison of the information with the second alert threshold fails to meet or exceed the threshold, or is not outside the range, then at 1240 the one or more heart failure symptoms need not be declared as detected.
  • FIG. 13 illustrates generally an example of at least a portion of method to determine heart failure status 1300.
  • user-selectable indicators are displayed, such as those shown in the user interface of FIG. 4 .
  • user input can be received such as by using a first display 120A and a first user input 110A, or a second display 120B and a second user input 110B.
  • a second test can be performed at 1350. In FIG.
  • Diastolic heart failure can occur when heart tissue cannot relax normally during diastole. Diastole can be thought of as the resting phase of the heart's pumping cycle. Such an abnormal lack of relaxation can diminish the heart's ability to properly re-fill with blood, reducing the heart's ability to pump an adequate amount of blood (e.g., hemodynamic insufficiency). Diastolic heart failure, coupled with one or more abnormal psychological conditions, can result in amplified respiratory symptoms or one or more other symptoms.
  • increasing an effect of respiration-related information can include changing an alert threshold or alert range associated with at least one sensor to increase a sensitivity 310 of the alert.
  • increasing an effect of respiration-related information can include increasing a weight of information derived from one or more respiration-related sensors with respect to one or more non-respiration-related sensors.
  • Respiration-related information can include one or more of respiration rate information, respiration timing information, lung tidal volume information, physiologic patient status parameters such as shortness of breath, exercise tolerance (e.g., a physiologic response to physical activity), or information derived from one or more other sensors.
  • Respiration-related information can also include one or more derived parameters, determined using information from one or more sensors, such as minute ventilation (e.g., a volume in liters exhaled by a person during a minute), or one or more other parameters.
  • a recommendation can be made to increase an effect of an intrathoracic impedance information, or information from one or more other sensors, on the HF status indicator.
  • increasing an effect of intrathoracic impedance information can include reducing an alert threshold or narrowing an acceptable range associated with an intrathoracic impedance sensor, or increasing a weight of information from intrathoracic impedance sensor with respect to one or more other sensors.
  • Intrathoracic impedance-related information can also be derived from a physiologic patient status parameter such as wetness, or one or more other physiologic patient status parameters.
  • a recommendation can be made to increase an effect of one or more of information related to respiration rate, respiration timing, heart rate, lung tidal volume or physical activity level, information derived from a combination (e.g., minute ventilation), or a physiologic patient status parameter such as shortness of breath.
  • one or more of a recommendation at 1380, a recommendation at 1360, or a recommendation at 1370 can be confirmed by a user.
  • a worsening heart failure condition determination or one or more other individual alerts can be updated.
  • one or more of the method examples can be implemented as a portion of the heart failure status processor 150.
  • some or all of the HF status processor 150 can be included as a portion, part, or component of the first external device 510, the second external device 520, the implantable sensor assembly 550, or the external sensor assembly 540.
  • a recommendation can be made to adjust (e.g., increase or decrease, or otherwise modify) an effect one or more physiologic patient status parameters related to the one or more user-selected heart failure comorbidities.
  • FIG. 14 illustrates generally an example of at least a portion of a method to determine heart failure status 1400.
  • one or more physiological patient status parameters can be used to detect one or more heart failure comorbidities in addition to or instead of using a user selection.
  • information obtained from a first physiological patient status parameter can be compared with a third alert threshold or range.
  • one or more heart failure comorbidities can be declared as detected (e.g., without requiring a user selection of the abnormal psychological condition).
  • an alert or warning can be generated.
  • the comparison of the information with the third alert threshold fails to meet or exceed the threshold, then at 1440 the one or more heart failure comorbidities need not be declared as detected.
  • a worsening HF status determination can be made based on the one or more abnormal psychological conditions declared at 1130 as shown in FIG. 11 , the one or more HF symptoms declared at 1230 as shown in FIG. 12 , or the one or more heart failure comborbidities declared at 1430, as if one or more of the detected abnormal psychological conditions, HF symptoms, or heart failure comorbidities had been selected by a user.
  • a worsening HF status determination can automatically compensate for an onset of one or more of depression or another abnormal psychological condition, one or more heart failure symptoms, or one or more heart failure comorbidities.
  • programming changes prompted by such automatic compensation to a worsening HF status determination, or to one or more monitoring parameters associated with one or more sensors can be overridden or modified by a user, such as during a verification process.
  • Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples.
  • An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, the code may be tangibly stored on one or more volatile or non-volatile computer-readable media during execution or at other times.
  • These computer-readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), or the like.

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Claims (13)

  1. Système (100), comprenant :
    une entrée d'utilisateur (110) configurée pour :
    recevoir une sélection par utilisateur d'un symptôme de défaillance cardiaque pour indiquer si oui ou non un symptôme de défaillance cardiaque est ou a été présent, dans lequel le symptôme de défaillance cardiaque inclut au moins un symptôme pris parmi une dyspnée, un oedème et une variation de poids ; et pour
    recevoir une sélection par utilisateur d'une condition psychologique anormale pour indiquer si oui ou non une condition psychologique anormale est ou a été présente ; et
    un processeur d'état de défaillance cardiaque (HF) (150), couplé à l'entrée d'utilisateur, le processeur d'état HF étant configuré pour déterminer un état de défaillance cardiaque en utilisant une information relative à la sélection par utilisateur du symptôme de défaillance cardiaque, une information relative à la sélection par utilisateur de la condition psychologique anormale et une information en provenance d'un détecteur de paramètre d'état physiologique de patient, caractérisé en ce que le processeur d'état HF est en outre configuré pour augmenter une sensibilité (310) de la détermination de condition de défaillance cardiaque en réponse à l'information reçue par l'entrée d'utilisateur, dans lequel l'information inclut la sélection par utilisateur indiquant qu'une condition psychologique anormale est ou a été présente.
  2. Système selon la revendication 1, comprenant un indicateur d'état de défaillance cardiaque (HF) configuré pour fournir une indication d'état de défaillance cardiaque en utilisant une information en provenance du processeur d'état HF.
  3. Système selon l'une quelconque des revendications 1 et 2, dans lequel le processeur d'état HF est en outre configuré pour régler de façon contrôlable au moins un élément pris parmi une spécificité, une valeur prédictive positive et une valeur prédictive négative de la détermination de condition de défaillance cardiaque en utilisant une information relative aux sélections par utilisateur du symptôme de défaillance cardiaque et de la condition psychologique anormale.
  4. Système selon l'une quelconque des revendications 1 à 3, dans lequel la condition psychologique anormale inclut au moins une condition prise parmi une anxiété, un stress et une dépression.
  5. Système selon l'une quelconque des revendications 1 à 4, comprenant le détecteur de paramètre d'état physiologique de patient, et dans lequel le détecteur de paramètre d'état physiologique de patient est couplé à au moins un capteur et est configuré pour recevoir une information physiologique relative à un patient en provenance de l'au moins un capteur, l'au moins un capteur étant choisi parmi une liste incluant une balance, un capteur de pression sanguine, un capteur d'électrocardiogramme, un accéléromètre, un capteur d'impédance intrathoracique, un capteur acoustique, un capteur de respiration et un capteur de gaz du sang.
  6. Système selon la revendication 5, dans lequel l'information physiologique inclut au moins une information prise parmi un poids, un rythme cardiaque, une vitesse de respiration, un cadencement de respiration, une pression sanguine, un volume tidal de poumon, un niveau d'activité physique, une impédance intrathoracique, un cadencement de bruit du coeur et une amplitude de bruit du coeur.
  7. Système selon l'une quelconque des revendications 1 à 6, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le processeur d'état HF est configuré pour recevoir une information relative à une impédance intrathoracique en provenance du détecteur de paramètre d'état physiologique de patient en réponse à une information reçue depuis l'entrée d'utilisateur, et dans lequel :
    l'information en provenance de l'entrée d'utilisateur inclut une sélection par utilisateur consistant en ce qu'un oedème est ou a été présent.
  8. Système selon l'une quelconque des revendications 1 à 7, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le processeur d'état HF est configuré pour recevoir une information relative à au moins une information prise parmi une vitesse de respiration, un cadencement de respiration, un volume tidal de poumon et un niveau d'activité physique en provenance du détecteur de paramètre d'état physiologique de patient en réponse à une information reçue depuis l'entrée d'utilisateur, et dans lequel :
    l'information en provenance de l'entrée d'utilisateur inclut une sélection par utilisateur consistant en ce qu'une dyspnée est ou a été présente.
  9. Système selon l'une quelconque des revendications 1 à 8, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le détecteur de paramètre d'état physiologique de patient est configuré pour recevoir une information relative à des premier et second paramètres d'état de patient et dans lequel :
    le processeur d'état HF est configuré pour régler de façon contrôlable un premier poids pour une information relative à un premier paramètre d'état physiologique de patient par rapport à un second poids pour une information relative à un second paramètre d'état physiologique de patient différent ; et dans lequel :
    le processeur d'état HF est configuré pour régler de façon contrôlable une détermination d'état de défaillance cardiaque en utilisant l'information reçue depuis le détecteur d'état physiologique de patient relative aux premier et
    second paramètres d'état physiologique de patient en conjonction avec les premier et second poids.
  10. Système selon l'une quelconque des revendications 1 à 9, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le détecteur de paramètre d'état physiologique de patient est configuré pour recevoir une information rapportée à la respiration relative à un patient, dans lequel :
    le processeur d'état HF est configuré pour régler de façon contrôlable la détermination d'état de défaillance cardiaque, le réglage contrôlable incluant l'augmentation d'un effet de l'information rapportée à la respiration sur la détermination d'état de défaillance cardiaque en réponse à la sélection par utilisateur reçue par l'entrée d'utilisateur indiquant si oui ou non une condition psychologique anormale est ou a été présente, et dans lequel :
    la condition psychologique anormale inclut une dépression.
  11. Système selon l'une quelconque des revendications 1 à 10, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le détecteur de paramètre d'état physiologique de patient est configuré pour recevoir une information relative à une impédance intrathoracique d'un patient, et dans lequel :
    le processeur d'état HF est configuré pour régler de façon contrôlable la détermination d'état de défaillance cardiaque, le réglage contrôlable incluant l'augmentation d'un effet de l'information d'impédance intrathoracique sur la détermination d'état de défaillance cardiaque en réponse à la sélection par utilisateur reçue par l'entrée d'utilisateur indiquant qu'un oedème est ou a été présent.
  12. Système selon l'une quelconque des revendications 1 à 11, comprenant le détecteur de paramètre d'état physiologique de patient, dans lequel :
    le détecteur de paramètre d'état physiologique de patient est configuré pour recevoir une information relative à au moins une information prise parmi un rythme de respiration, un cadencement de respiration, un rythme cardiaque,
    un volume tidal de poumon et un niveau d'activité physique, dans lequel :
    le processeur d'état HF est configuré pour régler de façon contrôlable la détermination d'état de défaillance cardiaque, le réglage contrôlable incluant l'augmentation d'un effet de l'information relative à au moins une information prise parmi le rythme de respiration, le cadencement de respiration, le rythme cardiaque, le volume tidal de poumon et le niveau d'activité physique en réponse à la sélection par utilisateur reçue par l'entrée d'utilisateur indiquant qu'une dyspnée est ou a été présente.
  13. Système selon l'une quelconque des revendications 1 à 12, dans lequel l'entrée d'utilisateur est configurée pour recevoir une sélection par utilisateur d'une comorbidité de défaillance cardiaque (HF) pour indiquer si oui ou non une comorbidité HF est ou a été présente, et dans lequel le processeur d'état HF est configuré pour déterminer un état de défaillance cardiaque en utilisant une information en relation avec la sélection par utilisateur de la comorbidité HF.
EP09792660.4A 2008-09-19 2009-09-17 Système pour déterminer l'état d'insuffisance cardiaque Not-in-force EP2361035B1 (fr)

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JP2012502752A (ja) 2012-02-02
US8469898B2 (en) 2013-06-25
US20130226011A1 (en) 2013-08-29
JP5373915B2 (ja) 2013-12-18
WO2010033699A1 (fr) 2010-03-25
AU2009293198A1 (en) 2010-03-25
EP2361035A1 (fr) 2011-08-31
US20160228072A1 (en) 2016-08-11
AU2009293198B2 (en) 2013-07-04
US9351647B2 (en) 2016-05-31
US20100076321A1 (en) 2010-03-25

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